Surgical Neonatal Intensive Care Unit Research Articles

70 Implementation of nurse facilitated, structured, post-event clinical debriefs in four neonatal intensive care units using the INFO model

Abstract Background Neonatal intensive care units (NICUs) often experience acute clinical events. Post-event team debriefs can reinforce success, identify areas for improvement, and improve healthcare providers’ (HCP) psychological coping. However, barriers exist to successful debriefs, and poor debriefs can increase HCP stress. Objectives To implement and evaluate structured post-event clinical debriefs for NICUs within a regional neonatal program. Design/Methods We assembled a multi-disciplinary implementation team, adapted an existing tool (INFO Clinical Debriefing Tool), and identified champions for each site (2 level 2 NICUs, 1 level 3 perinatal NICU, and 1 level 4 surgical NICU). A REDCap database, debrief triggers, feedback process for recommendations to quality improvement leads and frontline HCPs were developed. We chose charge nurses as facilitators as they were consistently present but were not team leads. Facilitators were trained in 2-hour Zoom sessions with a didactic presentation followed by simulated debriefing practice. Debriefs were then started and tracked. A post-implementation survey was conducted at 6 months. Results Eighty-one HCPs responded to the pre survey, identifying time stress and skill / availability of facilitators as main barriers. Most nurses (75%) were comfortable participating in debriefs; this approached 100% in other disciplines. However, there were negative experiences reported. (Table 1) Ninety-five debriefs were conducted in 6 months; 50% were delivery room resuscitations, 14% were in-unit events. Median 7 (IQR 5-8) HCPs attended; 85% had 3 or more disciplines attending. Most (81%) were led by trained facilitators, with 80% led by nurses or respiratory therapists. Debriefs took a median 12 minutes (IQR 8-17), and generated recommendations for improvements to equipment, team communication, and processes. Two sites had more success with uptake, facilitated by consistent presence of champions. Barriers to implementation included: availability of trained facilitators, time constraints, competing unit priorities. The post survey (85 responses) showed a positive view of INFO debriefs. Most respondents (88%) had participated in at least 1 debrief; of these 76% report positive / very positive experience, 76% thought team members always had the chance to speak up, and 78% felt the INFO process provided an effective mechanism for communicating concerns. Participants still listed time pressure as the main barrier.(Table 2) Conclusion Nurse-led, structured post-event clinical debriefs can be implemented in NICUs and are positively viewed by participants. NICUs experience implementation barriers that need to be considered.

Case–control study of milk curd obstruction in newborn infants in a tertiary surgical neonatal intensive care unit

BackgroundMilk curd obstruction (MCO), in which milk becomes inspissated, is a rare, serious, complication of preterm birth. Case reports implicate male sex and bovine-derived human milk fortifier (HMF) use as...

Comparison of Short vs. Extended Antibiotic Durations for Patients in the Neonatal Intensive Care Unit with Late Onset, Culture-negative Sepsis

Abstract Background Culture-proven late-onset sepsis in neonates and preterm infants, defined as symptom onset after 3-7 days of life, is a common cause of morbidity and mortality. Some patients are treated with antibiotics for sepsis despite lack of positive cultures after 48 hours of incubation, potentially due to the non-traditional signs of sepsis. Controversy remains over optimal treatment durations of culture-negative sepsis with durations reported as 2 to 7 days, and rarely longer than 7 days. The primary outcome of this study is to compare lack of symptom resolution at 7 days in patients with negative cultures treated with antibiotics for either ≤72 hours or >72 hours. Methods This was a single-center, retrospective, cohort study with Institutional Review Board approval at a 60 bed, level 4, surgical referral neonatal intensive care unit from January 1, 2020, to December 31, 2021. Patients were included for screening if they were ≥7 days of age, ≤ 44 weeks postmenstrual age, and received more than 1 day of antibiotics for possible late-onset, culture-negative sepsis. Patients were then excluded if they had positive culture results from any site, diagnosis of pneumonia, were being treated for suspicion of necrotizing enterocolitis, received antibiotics prior to obtaining cultures, or had continued treatment of prior infection. Patients were divided into two groups based on antibiotic duration: ≤72 hours or >72 hours. Presenting symptoms and symptom resolution at 72 hours and 7 days were assessed. Chi-squared or Fisher’s exact tests were used for categorical comparisons. Results Of the 909 patients screened, 68 were included: 42 in the ≤72 hours group and 26 in the >72 hours group. The most prevalent symptoms prompting antibiotic initiation were elevated CRP (64.7%) and bradycardia/oxygen desaturations (78%), with elevated CRP being the initiating symptom more frequently in the >72-hour group (92% vs 48%, p<0.001). If patients had 2 or more symptoms, they were more likely to receive >72 hours of antibiotics (85% vs 62%, p=0.034). At 7 days, 28 (41%) patients had complete symptom resolution. Antibiotic duration ≤72 hours was not associated with symptom resolution at 7 days (50% symptom resolution in the ≤72-hour group vs 27% in the > 72-hour group, p=0.06). Lack of symptom resolution at 72 hours of antibiotics was associated with lack of resolution at 7 days (p<0.001). Among patients without symptom resolution at 7 days, 65% of patients had a persistently elevated CRP and 68% of patients continued to have bradycardia/oxygen desaturations. Conclusion In neonates and preterm infants with negative cultures but possible signs of sepsis, antibiotic duration does not impact 7-day symptom resolution. Results indicate that if the initiating symptom is not resolved at 72 hours despite negative cultures, it is unlikely to be resolved with additional days of antibiotics. This is likely due to the multifactorial potentially non-infectious etiology of initiating symptoms in these patients. It is appropriate to discontinue antibiotics if cultures are negative after 48 hours of incubation in this population.

Mental health screening for parents following surgical neonatal intensive care unit (NICU) discharge

Admission to the surgical neonatal intensive care unit (sNICU) is a stressful experience. Care is often complex, with inherent risks and potential complications. This study describes the implementation of an outpatient mental health screening process for parents of infants admitted to a sNICU. Parents of infants aged >34 weeks gestation with a congenital anomaly requiring neonatal surgery participated in this prospective observational study. Standardised measures to screen for parenting stress (Parenting Stress Index™ Fourth Edition Short Form) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) were administered at the first outpatient visit scheduled when the infant's corrected gestational age was 4 months. A triage algorithm was developed, to review the initial screening results prompting appropriate action and intervention. Positive screens were triaged as evaluate (assess within 48 h), targeted information (email contact), or escalate response (same day risk assessment). Demographic factors associated with parental stress and depressive symptoms were explored. Forty parents (response rate: 88 %) participated in screening. A high portion of parents (52.5 %) required secondary screening, for parenting stress (n = 10), depressive symptoms (n = 5) or both stress and depressive symptoms (n = 6). Socioeconomic disadvantage was positively associated with parenting stress (p = 0.02) and greater depressive symptoms with parent education levels (p = 0.01). Results indicate screening of parent mental health in the outpatient setting is feasible. Use of a triage algorithm helped prioritise parent follow-up and facilitate workflows. Parent mental health screening should be prioritised within and beyond the sNICU to support family and infant outcomes during this critical period of development.

A Comparison of Sequelae After a Practice Change From Vancomycin to Ampicillin Containing Antibiotic Regimens for Necrotizing Enterocolitis.

The aim of this study was to compare sequelae and acute kidney injury (AKI) occurrence among patients with necrotizing enterocolitis (NEC) after changing institutional guidelines replacing vancomycin with ampicillin for gram-positive coverage. This was a retrospective, single-center cohort analysis of patients from 2016-2020 (n = 73) with NEC at a surgical neonatal intensive care unit with a high community prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Multivariate logistic regression was utilized to assess associations. Twenty-five (34%) patients had at least 1 sequela related to NEC. Ampicillin containing regimens were not associated with any sequelae type or AKI. Postmenstrual age < 29 weeks at diagnosis ([OR] 5.8 [1.2-28.8], P = .03; and receipt of vasopressors [OR] 3.3 [1.1-10.2], P = .04) were independently associated with sequalae. Stage III NEC was independently associated with AKI, OR 10.6 (2-55.6), P = .005. In conclusion, ampicillin-containing regimens are effective for NEC management at our institution despite a high prevalence of MRSA.

Hydrocolpos causing bowel obstruction in a preterm newborn: a case report

BackgroundImperforate hymen is the most common congenital defect of the female urogenital tract. The spectrum of clinical manifestations is broad, ranging from mild cases undiagnosed until adolescence to severe cases of giant intraabdominal masses. The most common complication of hydrocolpos is bladder compression, resulting in obstructive uropathy and hydronephrosis.Case presentationWe present here the case of a preterm neonate who was admitted to the surgical neonatal intensive care unit for bowel obstruction. The baby did not appear septic or unwell, a small amount of meconium passed frequently, and no bilious gastric residuals occurred. Based on these findings, acute abdominal obstruction was doubtful, and the surgeon chose a conservative (watch and wait) approach. Subsequently, we performed abdominal ultrasound and magnetic resonance imaging based on unclear information about a suspicious abdominal mass raised by the gynecologist shortly before the emergency C-section. The final diagnosis was congenital hydrocolpos due to imperforate hymen. The pediatric gynecologist indicated an incision of the imperforate hymen under general anesthesia. The incision resolved abdominal distention as well as the bowel obstruction.ConclusionThe presentation of hydrocolpos was not typical (no bulging in the vaginal introitus) in our case, and clinical symptoms implied acute bowel obstruction shortly after birth. The surgeon chose a conservative (watch and wait) approach as the baby did not appear unwell on the second day of life. Fortunately, diagnostic laparotomy was not required as the next step in bowel obstruction management. All clinical symptoms resolved after a minor surgical procedure.

Developmental care education in Australian surgical neonatal intensive care units: A cross-sectional study of nurses’ perceptions

BackgroundNurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses’ perceptions of developmental care. ObjectiveTo determine perceptions and attitudes towards developmental care in a specialty neonatal setting. DesignCross-sectional study. SettingsTwo surgical neonatal intensive care units in Australia. ParticipantsRegistered nurses permanently employed at the study sites between May 2021 to April 2022. MethodsA modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses’ perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)]. ResultsOf 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3–8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1–6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1–6.2]. ConclusionsThe results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

Factors that determine first intubation attempt success in high-risk neonates.

Approximately 50% of all neonatal endotracheal intubation attempts are unsuccessful and associated with airway injury and cardiorespiratory instability. The aim of this study was to describe intubation practice at a high-risk Neonatal Intensive Care Unit (NICU) and identify factors associated with successful intubation at the first attempt. Retrospective cohort study of all infants requiring intubation within the Royal Children's Hospital NICU over three years. Data was collected from the National Emergency Airway Registry for Neonates (NEAR4NEOS). Outcomes were number of attempts, level of operator training, equipment used, difficult airway grade, and clinical factors. Univariate and multivariate analysis were performed to determine factors independently associated with first attempt success. Three hundred and sixty intubation courses, with 538 attempts, were identified. Two hundred and twenty-five (62.5%) were successful on first attempt, with similar rates at subsequent attempts. On multivariate analysis, increasing operator seniority increased the chance of first attempt success. Higher glottic airway grades were associated with lower chance of first attempt success, but neither a known difficult airway nor use of a stylet were associated with first attempt success. In a NICU with a high rate of difficult airways, operator experience rather than equipment was the greatest determinant of intubation success. Neonatal intubation is a high-risk lifesaving procedure, and this is the first report of intubation practices at a quaternary surgical NICU that provides regional referral services for complex medical and surgical admissions. Our results showed that increasing operator seniority and lower glottic airway grades were associated with increased first attempt intubation success rates, while factors such as gestational age, weight, stylet use, and known history of difficult airway were not. Operator factors rather than equipment factors were the greatest determinants of first attempt success, highlighting the importance of team selection for neonatal intubations in a high-risk cohort of infants.

Parents' perspectives on their baby's pain management in a surgical neonatal intensive care unit: The parents' awareness and involvement in pain management (PAIN-PAM) study - Part 2

Parents' whose babies underwent surgery, completed five days of stay in the surgical neonatal intensive care unit (NICU) and were literate in English, participated in this exploratory cohort study. Parents provided written responses to two open-ended questions relating to their baby's pain management. Thematic analysis of data from 52 parents revealed four major themes: Information Resources; Communication Practices; Barriers to Parental Role; and Staff Appreciation. The majority of parents wanted information provided in different formats about how to recognise their babies' pain and how to comfort their babies in addition to discussions with clinicians. They also wanted the choice to stay with their baby during painful procedures. A barrier to this was COVID-19 restrictions. Twenty-nine percent of parents responded that no additional resources were required. The findings highlight the need to improve parent-focussed resources and clinician education to better inform and support parents' involvement in managing their babies' pain in the surgical NICU.

Parental perceptions and experiences of care in the surgical neonatal intensive care unit

BackgroundParents endure significant stress when their newborns require surgery while in the neonatal intensive care unit (NICU). Our study aims to explore the surgical NICU experience from the parents’ perspective and identify areas that may improve this experience. A secondary objective was to integrate their feedback to refine the implementation strategy of the neonatal enhanced recovery after surgery (ERAS®) guideline.MethodsIn December 2019, five surgical NICU parents participated in a focus group. Conversation surrounded parents’ perspectives and experiences of the surgical NICU. Inductive analysis was performed to identify data, themes, and concepts that emerged from the discussion.ResultsParticipants identified four major interrelated themes that impacted the surgical parents’ NICU experience. These themes include (1) parental state, both physical and emotional, (2) the altered parental caregiver role which necessitates identifying alternative meaningful parental experiences, (3) the care team dynamic, incorporating consistency and effective communication, and (4) the discharge process which may be significantly eased through graduated, hands-on training.ConclusionKey elements of the neonatal ERAS® guideline address major themes and stressors identified by parents. The parental perspective may help clinicians appreciate the parent surgical NICU experience and assist in improving family-centered care to surgical infants and their families.

Does developmental care education alter nurses’ perceptions of developmental care practices in surgical neonatal intensive care units?

Does developmental care education alter nurses’ perceptions of developmental care practices in surgical neonatal intensive care units?

Parental participation in care during Neonatal Intensive Care Unit stay: a validation study

Introduction: Although the Neonatal Intensive Care Units (NICU) can offer lifesaving care for vulnerable newborns after birth, separation from the parents, pain, sleep disruptions, and environmental stressors can be traumatic experiences for these critically ill newborns. At the same time, the new parents can experience a situation they are not prepared for, such as separation from the newborn, and fear of the unknown, which, together disrupt the family ties, which are created and strengthened right during the moment of birth. Evaluating the participation of the parents in neonatal care during their children’s stay in the NICU allows health professionals to highlight possible gaps in the correct management of the babies by the parents, intervening where it is necessary, with proper education and support. Aim: To validate the Italian version of “The Scale of Parental Participation in Care: Neonatal Intensive Care Unit” (PPCS: NICU). Methods: The study was conducted in a 22-bed mixed (medical and surgical) NICU of a public hospital. The study participants comprised parents whose infants were admitted to the NICU from April to August 2022. Results: A total of 128 parents were included in the study. Exactly half of the sample was female, and the average age was 33.43 ± 6.51 years; 31.25% (n=40) of the sample already had a first child. Those who had a history of previous abortion were 25% (n=32). Additionally, 3.12% (n=4) of parents experienced a previous death of their child. About the type of delivery, 54.69% (n=70) of the sample experienced vaginal birth, 17.19% (n=22) of them underwent an elective cesarean, and 28.12% (n=36) underwent an emergency cesarean. Item analysis was performed on all 16 items. The corrected total item correlation coefficients for the scale items were adequate between 0.408 and 0.821. Cronbach’s alpha was 0.926. Conclusion: The Italian version of the PPCS: NICU shows high reliability and therefore, it can be used in the context of Italian NICUs to assess the degree of parental participation in neonatal care, allowing early identification of critical issues by parents in the care of newborns admitted to NICU.

Comparison of Breastfeeding Success by Mode of Delivery.

This article identifies how mode of delivery and the presence of labor affect the initiation and effectiveness of breastfeeding. This is a retrospective cohort study of breastfeeding success after vaginal delivery, cesarean section after labor, and scheduled cesarean section in term, singleton deliveries in nulliparous patients at a large academic institution from 2017 to 2018. Exclusion criteria included major postpartum complications requiring admission to the surgical intensive care unit or neonatal intensive care unit, general anesthesia, and major fetal anomalies. Breastfeeding success in the immediate postpartum period, defined as the first 2 to 3 days postpartum prior to hospital discharge, was measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life. Multivariable linear and logistic regression were used to assess the association between mode of delivery and markers of breastfeeding success after adjusting for potential confounders. A Tukey's post hoc analysis with pairwise comparisons was performed to assess differences in breastfeeding outcomes between vaginal delivery, scheduled cesarean section, and cesarean section after labor. A total of 2,966 women met inclusion criteria during the study period, 1,936 (65.3%) of whom underwent spontaneous vaginal delivery, 415 (14.0%) of whom delivered by scheduled cesarean section, and 615 (20.7%) of whom underwent cesarean section after labor. There were significant differences in maternal age, obesity, race/ethnicity, insurance status, gestational age at delivery, birth weight, and 1-minute Apgar's score less than 7 between vaginal delivery, scheduled cesarean section, and cesarean section after labor. There were also significant differences between indication for oxytocin, type of anesthesia, and postpartum hemorrhage between the three groups. After controlling for these factors, women who underwent vaginal delivery were more likely to have infants with decreased need for formula supplementation (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.52-1.93) and were less likely to switch from breast to formula feeding (aOR = 1.71, 95% CI: 1.04-1.31) in comparison to women who delivered via cesarean section in labor or scheduled cesarean section. The infants of these women also had an increased number of breastfeeding sessions on average (β = 0.06, p = 0.002), required fewer number of daily formula feedings (β = 0.14, p < 0.001), and experienced a smaller percentage in neonatal weight loss over the first 2 to 3 days of life (β = 0.18, p < 0.001) compared to those born after cesarean section and cesarean section after labor. These women comparatively required less time at each breastfeeding session (β = 0.06, p = 0.005), and produced fewer wet diapers and stools on average (β = 0.12, p < 0.001 and β = 0.12, p < 0.001, respectively). On post hoc analysis with pairwise comparisons, and on separate sensitivity analysis of only women who underwent cesarean delivery, there was no difference in breastfeeding outcome measures between scheduled cesarean section and cesarean section in labor. Women who deliver by cesarean section, despite the presence or absence of labor, are less likely to maintain exclusive breastfeeding postpartum and are more likely to require formula supplementation. These women may need more support with breastfeeding after surgery in order to experience similar benefits for neonatal growth and weight gain. · Women who deliver by cesarean section are less likely to maintain exclusive breastfeeding.. · Women who deliver by cesarean section are more likely to require formula supplementation.. · Women may need more support with breastfeeding after cesarean delivery..

Effect of Competency Based Training Program on Nurses' Performance Regarding Endotracheal Tube Suction for Neonates on Mechanical Ventilator

Background: Clinical nursing competence is the capacity to apply care by integrating information, skills, attitude, beliefs, and experience. It reflects the nursing professional's feelings, ideas, and judgement. Aim: the study aimed to evaluate the effect of Competency Based Training Program on Nurses' Performance Regarding Endotracheal Tube Suction for Neonates on Mechanical Ventilator. Method: A quasi-experimental design was used to conduct the study at Neonatal Intensive Care Units (NICUs) and Surgical Neonatal Intensive Care Unit "SNICU" of Benha Specialized Pediatric Hospital. The study included 70 nurses who working in the previously mentioned setting. Tools: Researchers used five tools as; a structured interviewing questionnaire, an observational checklist, nurses' attitude questionnaire, Nurse Competence Scale, and nurses' opinion questionnaire. Results: Less than three quarters of studied nurses had good knowledge and the most of them had competent practice post competency-based training program. Also, the majority of nurses had positive attitude post competency-based training program and there was highly statistically significant difference in nurses' competence score pre and post competency-based training program. Conclusion: The implementation of the competency-based training program improved nurses' performance regarding endotracheal tube suction for neonates on mechanically ventilated. Recommendation: Develop periodic educational and training courses for nurses working at the neonatal intensive care units regarding care of endotracheal tube suction for neonates on mechanical ventilator. Further research should be done with large sample is recommended to ensure generalization of the results.

Prognostic Role of Procalcitonin and C-reactive Protein in Surgical Neonates: A Single-Institution Experience.

IntroductionNeonatal sepsis is a dynamic process where the rigorous evaluation of clinical signs along with appropriately selected biomarkers guides the diagnosis of sepsis. Procalcitonin (PCT) and C-reactive protein (CRP) are the two most commonly used diagnostic biomarkers used in sepsis. Sepsis remains the most important cause of mortality and morbidity in surgical neonates. A cross-sectional study was conducted to assess the prognostic predictability of PCT and CRP in neonatal surgical sepsis.MethodsAll the neonates admitted to the neonatal surgical intensive care unit between January 2019 and December 2020 with features of sepsis were included in the study. Blood cultures, CRP, and PCT on Day one (PCT1) and Day three (PCT3) of suspicion of sepsis were evaluated. The receiver operating characteristics curve was studied to estimate the probability of two markers to predict the mortality in neonatal sepsis.ResultsOf 102 surgical neonates, 63 neonates had early-onset sepsis while 23 (22.5%) neonates died and 30 neonates reported positive blood culture. There was a decline in the overall PCT trend from PCT1 and PCT3, while a significant PCT rise was noted for the non-survival group (p= 0.003). At cut-off of 5 mg/dl for CRP and 2.5 ng/dl for PCT1 and PCT3, the sensitivity (36.0%, 25.8%, 100%), specificity (84.1%, 83.3%, 97.5%), positive predictive value (52.2%, 73.9%, 91.3%), and negative predictive values (73.4%, 38.0%, 100%) were observed.ConclusionPCT on Day three of suspected sepsis has higher sensitivity, specificity, and accuracy for prognostication of surgical neonatal sepsis at the cut-off value of 2.5 ng/ml. The rising trend of PCT levels is indicative of a poor prognosis.

Effect of colostomy empowerment program for mothers on occurrence of peristomal skin complications among their infants

Colostomy is often a life-saving procedure but is still associated with significant morbidity. Aim of the study: To evaluate the effect of colostomy empowerment program (CEP) for mothers on occurrence of peristomal skin complications among their infants. Design: Quasi -experimental design was utilized. Sample: A convenient sample of 60 infants undergoing colostomy operation and their mothers. Setting: The current study conducted in three settings at Cairo University Specialized Pediatric Hospital (CUSPH) (surgical neonatal intensive care unit, in-patient surgical unit, and the out-patient surgery clinic).Tools for data collection: Tool I structured interview questionnaire; Tool II mothers’ knowledge and reported practice assessment sheet pre-posttest; Tool III observational checklist and tool IV complications recording sheet. Results: There were statistically significant differences regarding total mean score of mothers' knowledge, reported practice and skills in both groups. Peristomal skin complications were higher in the control group. Conclusion: The current study concluded that after CEP, there was a significant improvement in the level of knowledge, reported-practices, and skills among mothers in the study group. Infants in the study group were exposed to less postoperative complications regarding peristomal skin complications than infants in the control group.

Hedgehog Signal Defect Leading to Familial Exudative Vitreoretinopathy-Like Disease and Gastrointestinal Malformation.

Objectives:The aim of the study was to present a new genetic association presenting with gastrointestinal tract malformations (GTMs) and familial exudative vitreoretinopathy (FEVR)-like disease and review the genetics of Hedgehog signaling.Materials and Methods:Three neonates were diagnosed with FEVR-like retinal vascular disease upon routine ophthalmological examination during hospitalization in the neonatal surgical intensive care unit for GTMs. Genetic analysis of the neonates was performed.Results:Gestational age of the neonates was 39, 38, and 39 weeks and birth weights were 3,500, 3,600, and 3,300 grams, respectively. All six eyes of the three infants were treated by laser photocoagulation. Recurrence was not seen in any of the eyes. Genetical analysis of all the neonates diagnosed with FEVR-like disease revealed defects in the Hedgehog pathway.Conclusion:FEVR is a genetically well-defined retinal vascular disease. The current study is the first to show an association between FEVR-like retinal vascular disease and GTMs. This study demonstrates the importance of the Hedgehog pathway in retinal vascular and gut development.

Do neonatal nurses′ perceptions agree with parents’ self-reported needs and stressors in a surgical neonatal intensive care unit?

To explore neonatal nurses' and parents’ perceptions of parental needs and stressors in a surgical neonatal intensive care unit (NICU) using the Neonatal Family Needs Inventory and Parental Stressor Scale:NICU. Matched data for 99 nurse-parent dyads showed only limited agreement (Gwet's agreement coefficients 0.23 - 0.26). Nurses recognised Assurance as parents' priority need and Parental Role Alteration as parents' greatest stressor. They identified 8 of parents' 10 most important needs and recognised parents' highest stressors. Nurses under-estimated the importance of mothers' (p's < 0.01, large effect sizes [ES]) but not fathers' needs. They under-rated parents' stress at feeling helpless to protect their baby and overrated stress around NICU sights and sounds (medium ES's). Nurses' years of NICU experience showed no significant effects. Greater awareness is needed of the importance and uniqueness of parents’ needs and stressors. Education to enhance attunement would better support individualized family-centred care.

Parents' awareness and use of nonpharmacological methods to manage their baby's procedural pain in a surgical neonatal intensive care unit

Parents whose babies had undergone major surgery and were admitted to the surgical neonatal intensive care unit for more than five days, and who could communicate in English were surveyed to explore their use of nonpharmacological methods to manage their baby's procedural pain in the post-operative period. Eighty-one parents, including 48 mothers, completed a 4-part questionnaire. Parents most frequently used physical and comforting touch methods to comfort their babies. Skin-to-skin care, sucrose, breastmilk-scented pads, and breastfeeding were least frequently used. While the majority of parents were aware of most unit practices regarding their baby's pain management, some practices needing greater awareness were identified. These findings highlight the need to promote a range of parent-led nonpharmacological pain management methods. This could be achieved by educating clinicians to collaboratively support and encourage parents' involvement in managing their baby's pain.

The Relationship Between Neonatal Surgery, Postpartum Depression, and Infant Clinical Course.

Postpartum depression (PPD) affects 10-15% of mothers in the general population, and studies show increased incidence for mothers of infants with serious health conditions. This study investigates incidence of PPD in mothers of surgical patients in the neonatal intensive care unit (NICU) and characterizes these patients' clinical and neurodevelopmental outcomes. This retrospective cohort study analyzed Nebraska's Tracking Infant Progress Statewide (TIPS) database and referring hospital medical records from February 2013 to June 2018. Upon NICU discharge, children were referred to the TIPS program, with scheduled follow-up appointments at approximately 6months corrected age. All patients seen in NICU follow-up clinic with recorded scores for maternal Edinburgh postnatal depression screen (EPDS) were eligible except infants with congenital heart disease as this cohort was previously studied. Patients were stratified into groups based on presence or absence of a general surgical procedure within the first 6 months of life and positive (≥ 10) or negative (< 10) EPDS score. Statistical analyses assessed for significant differences between groups regarding gestational age, birth weight, maternal age, length of NICU stay (LOS), number of days on a ventilator, payment method, ethnicity, developmental testing, and rate of referral for early intervention services. Of 436 patients, 83 were surgical patients (16 with positive EPDS; 19.3% incidence), and 353 were non-surgical patients (44 with positive EPDS; 12.5% incidence). Statistical analysis showed no significant relationship between neonatal surgery and positive EPDS (χ2 = 2.6, p = 0.1). While the surgical cohort had longer LOS and days on ventilator, maternal EPDS did not predict these factors. In the surgical cohort, mothers of children not independent on oral feeding at discharge were more likely to screen positive for depression (7/14, 50% vs. 7/61, 11%; p < 0.05). Mothers of surgical patients are not significantly more likely to screen positive for post-partum depression compared to other NICU mothers. This underscores the importance of routine screening for PPD in mothers of both surgical and non-surgical NICU patients in order to identify parents and children at risk.